The research team of Professor Zhu Jun and Liang Juan (National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University) has published an original research “Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births” in The British Medical Journal (BMJ, Impact factor: 20.79).

 Professor Zhu Jun and Liang Juan research team report that China has succeeded in reverting the rising trends in caesarean sections over the past 20 years, using data of nearly 7 million birth from China’s National Maternal Near Miss Surveillance System between 2012 and 2016. China is the only country that has succeeded in reverting the rising trends in caesarean sections which had an extremely high caesarean section rates in the past. This study indicates, a series of policies for reducing caesarean section established by the national or local health administrative department or the administrative department of the hospital is the basis. Even in the context of the continuous increase in the proportion of pregnant women with old age or a uterine scar caused by the relaxation of the one child policy, the caesarean section rate in China has continued to decline steadily year by year, especially in nulliparous women and multiparous women without a uterine scar. In the meantime, perinatal mortality declined substantially from 10.1 per 1000 births in 2012 to 7.2 per 1000 births in 2016, and there was no change in pregnancy related mortality over time. These results suggest that the reduction in cesarean section rate does not adversely affect maternal and child safety. The study concludes that with the relaxation of the comprehensive two child policy, the proportion of women with a uterine scar will further increase. Conditions will have to be created to maintain the safety of these women, while strategies to avoid medically unnecessary primary caesarean section need to be continually reinforced.

Background: Caesarean section plays an important role in managing dystocia, pregnancy complications, and reducing maternal and neonatal mortality. However, a series of health problems caused by overuse of cesarean section cannot be ignored. Caesarean section rates have increased over the world in recent years. The report from WHO in 2010 indicated that China had one of the highest caesarean section rates in the world. This report caught the attention of the Chinese government, a series of policies had been strengthened and introduced to reduce cesarean section. The relaxation of the one child policy in November 2013 and the introduction of the two child policy in October 2015. Although it may affect the option of mode of delivery when women delivered their first child, the proportion of pregnant women with old age or a uterine scar will also increase. This may lead to further increase in cesarean section rate.

Open access: Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births. http://www.bmj.com/content/360/bmj.k817 (Contributed by: Mu Yi, Li Xiaohong, and Zhu Jun. Source of picture: BMJ)